The Canadian Medical Association Journal has issued new guidelines to help manage concussions and reduce the risk of second-impact symptom, which can be fatal. These guidelines follow on the heels of a study that showed recent National Hockey League rule changes did not reduce the number of concussions among its players.

Major neurological deficits and even death can occur to people who sustain repeated concussions, particularly if they develop so-called “second-impact syndrome,” reported the article published in the Canadian Medical Association Journal (CMAJ).

Following a simple six-point return-to-play protocol for people who have sustained a concussion can reduce the risk of further injuries, wrote Charles Tator, MD, PhD, a professor in the department of surgery at the University of Toronto.